have been on Lexapro for over four years now and have never had to up my dosage beyond the initial 10 mg I started on. It is excellent in treating my anxiety disorder. However, since starting dialysis (i plan to be a home dialysis patient in a few months), the Lexapro became ineffective. I have doubled the dose and still am having a great deal of difficulty maintaining an even mood. Work has been almost impossible. I was reading that a treatment for Lexapro overdose is dialysis, so I am trying to find out if there are any studies that have studied dialysis patients and steps to maintain therapeutic levels while on dialysis. IS there some information I can direct my physician too? Have any of you had this problem?
Thanks,
Bill Biggs
Hi Bill,
I’m sorry to hear that your usual dose of Lexapro is no longer effective for your anxiety. It takes so darn long to find a drug that works, and anxiety can be so crippling, that I really do feel for you. There is a guide you can point your doctor(s) to about how drugs respond to dialysis. It’s called Dialysis of Drugs (there is a 2008 edition), and it’s put out by a group called Renal Pharmacy Consultants, LLC. The free pdf is here: http://www.ckdinsights.com/downloads/DialysisDrugs2008.pdf).
Unfortunately, there are no data (“ND”) on the dialyzability of Lexapro (escitalopram oxalate–you need to look under the drug’s generic name). It’s on page 30. So, no-one has done this study yet.
There are a number of other drugs that have been used to treat anxiety. We don’t know which ones you’ve tried before, but here’s what’s in the guide for some of the others–including only those that don’t have cautions for people with kidney failure (at least that I was able to find on http://www.rxlist.com:
Antidepressants/antianxiety drugs
– Celexa (citalopram) - Excreted by the liver & kidneys, may cause sodium loss - No data in standard HD, high flux HD, or PD
– Cymbalta (duloxetin) - Excreted by the liver, but may cause sodium loss - Removal is unlikely by standard HD, high flux HD or PD
– Effexor (venlafaxine) - Excreted by the liver & kidneys - Not removed by standard HD, no data in high flux HD, unlikely in PD
– Paxil (paroxetine) - Excreted by the liver & kidneys - Not removed by standard HD, no data in high flux HD, unlikely in PD
– Prozac (fluoxetine) - Excreted by the liver, but may cause sodium loss - Not removed by standard HD, no data in high flux HD, not removed by PD
– Remeron (mirtazepine) - Excreted by the liver & kidneys; can cause drowsiness - NO INFO
– Zoloft (sertraline) - Excreted by the liver - Not removed by standard HD, no data in high flux HD, unlikely in PD
Benzodiazepines (tranquilizers) - Can be addictive. ALL of the drugs below are Not removed by standard HD, no data in high flux HD, removal is unlikely by PD
– Ativan (lorazepam) -
– Dalmane (flurazepam) - Can cause sleep-driving & such
– Klonopin (clonazepam) - Excreted by the kidneys; can cause drowsiness
– Librium (chlordiazepoxide)
– Serax (oxazepam)
– Xanax (alprazolam)
– Tranxene (clorazepate)
– Valium (diazepam) - Excreted by the kidneys; may have more side effects.
Thank you so much for taking the time to respond and in such detail! I am seeing some signs of improvement the last few days although the doubts still nag loudly. I am going to forward you email to my nurse practitioner, I think he will find it valuable for the other 80 patients he deals with.
Thank you again.
You’re welcome, Bill, I’m glad you think it will be helpful. And good luck with your transition to home therapy! Come on back if you have more questions. 
